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NPI Code Detail

MEDICARE: DR. SAMUEL SUNGWON KIM M.D.

MEDICARE: DR. SAMUEL SUNGWON KIM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianA114873CA

General Provider Information

NPI Number : 1023310687
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMUEL SUNGWON KIM M.D.
Provider Business Mailing Address
First Line : 5400 BALBOA BLVD STE 326
Second Line :
City : ENCINO
State : CA
Zip : 91316-5214
Country : US
Telephone Number : 818-789-0941
Fax Number : 818-789-6726
Provider Business Practice Location Address
First Line : 5400 BALBOA BLVD STE 326
Second Line :
City : ENCINO
State : CA
Zip : 91316-5214
Country : US
Telephone Number : 818-789-0941
Fax Number : 818-789-6726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2010
Last Update Date : 01/05/2026

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Directions to “ DR. SAMUEL SUNGWON KIM M.D.” Practice Location

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